Nikki Sommer, a nurse practitioner with Key West Surgical Group joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Diverticulosis can be tough for folks.
Sommer explained, “You get these small pouches called diverticula. It’s a weakness in the wall of the colon, and they tend to balloon out over time. So a lot of times, people say, do you usually feel symptoms? No, not at all. Most people don’t even know they have it, and are told they have it after a colonoscopy. So the majority of the time, people are completely asymptomatic.
How common is it?
Sommer said, “It is very common, especially as we age. By the age of 60, up to 60% of the people may have diverticulosis. This is something we do see in clinical practice, and again, usually, well, two things happen, either you’re told when you have a colonoscopy, or, unfortunately, before you have a colonoscopy, you might actually have diverticulitis. Diverticulitis occurs when those pouches become inflamed or infected, and that’s when you have symptoms and problems really start, especially if you leave them untreated. So symptoms of diverticulitis are left lower abdominal pain. Pain, fever, nausea, constipation, or sometimes diarrhea. And then in more serious cases, it can lead to abscess that’s an infection, and because it is a balloon, so it kind of forms an abscess in that pocket, and then it can perforate the colon wall, and then you can get an infection throughout your abdomen that’s known as peritonitis. So it can turn into something pretty hairy, and can lead to very bad complications if left untreated. The pain probably starts before the fever does. I have never had it, but when I talk to people that have had diverticulitis, and it tends to reoccur, it usually occurs in the left lower quadrant and pain is a telltale sign. It’s something that doesn’t go away, and it starts as an ache, and the ache may come or go, and then it progresses, and that’s when, when people start to be like, this pain just isn’t getting better, and I’ve had it for several days, or that intermittent pain then becomes constant pain, and it’s almost like when you have appendicitis, which is on the lower right quadrant, people are doubled over in pain. I’ve seen people double over in pain from a really bad diverticulitis infection.”
If you have diverticulitis, you know it.
Sommer said, “The difference between them is, if you have diverticulosis, you are at risk for getting diverticulitis, because that’s what it is. It’s weakness in those pouches, in the diverticula. So if you’re not regular, and you’re constipated, or if you have hyperactivity, like lots of diarrhea, it can trigger that inflammation that can cause diverticulitis.”
Serious cases of diverticulitis can cause real problems.
Sommer said, “Perforation and infection in the abdomen. If you do have a perforation, it’s really serious, because then that infection just goes everywhere in your abdomen, and that is known as peritonitis. So normally, you will be hospitalized at that point and on heavy IV antibiotics, and sometimes you may need surgery. Sometimes diverticular bleeding can happen when a blood vessel in the pouch ruptures. It’s usually sudden, painless or bright red blood. Occasionally, patients will call and they will say, oh, I have rectal bleeding. And automatically they assume it’s hemorrhoids, and they’ll come in and it’s not hemorrhoids. But we know that they have diverticulosis, and it could be one of those little diverticula, they bleed.”
Can diverticulitis be prevented?
Sommer said, “When you have a diet high in fiber, it keeps you regular. So if you have diverticulosis, it’s important not to get backed up, or not to have that hyperactivity, but it’s more associated with constipation and a low fiber diet. So making sure you get the adequate amount of fiber, keeping you regular is important, because otherwise, if you do have diverticulosis and you have a low fiber diet, you are at risk for diverticulitis.”
Constipation can create extra pressure in the colon.
Sommer explained, “Because it’s a weak spot, and now you’re straining and it also means those pockets where bacteria gets trapped in. That’s the other thing. Your stool has, carries bacteria and your body gets rid of it. But if you’re backed up, it’s going to sit in those pockets and bacteria gets trapped in there. You need a high fiber diet. Then it’s the usual, obesity, smoking, and then certain medications, like non steroidal anti inflammatories, which is your Motrin, ibuprofen, naproxen and steroids, can cause pressure. So really interesting. If you overdo those things and you have diverticulosis, you really can’t get diverticulitis without diverticulosis. So just keep that in the back of your mind. If you have a colonoscopy and they tell you, oh, you’re good, you’re good.”
Hydration is also important to keep a person regular.
Sommer said, “Make sure you’re also well hydrated, especially if you are taking fiber or fiber supplements, they’re not going to work if you’re not also drinking enough water. Make sure you have regular bowel habits. Regular bowel movements, you’re not straining, you don’t wait for days before you go and stay active. Having an active lifestyle keeps everything in balance. Fiber helps to reduce the pressure in the colon and keeps things moving.”
How is diverticulitis diagnosed?
Sommer said, “After working in urgent care for several years, people come in with left lower abdominal pain, and again, a lot of times when they come in, they’re hurting, they have pain on their face, they’re grabbing their left side. So CAT scan is usually the test of choice. It will pick up on that inflammation in the colon right away. And then, usually, if they’ve never had a colonoscopy before, they’re going to recommend they have one once everything calms down, because colon cancer also can mimic or cause diverticulitis. If you have diverticulosis, it can be the polyp invading into that weak pouch. So a colonoscopy is usually recommended, especially after your first time of diverticulitis, and if you’ve never had a colonoscopy before, they’re going to recommend you get one once you’re healed.”
Is there treatment for diverticulitis?
Sommer said, “They call bowel rest, which means clear liquids, no solid foods, and you’re going to probably take some oral antibiotics for about 10 to 14 days, depending on the severity. For severe cases, if it’s left too long, and a lot of times the first time someone has diverticulitis, depending on the person, if you’re a worry wart, you’re going to go to the doctor right away, but I’ve seen where people have put it off, thinking it was nothing, and they end up in the hospital. So IV antibiotics, hospitalization, and then sometimes, depending if the abscess is not clearing, they need to go in and drain it. And if there’s perforation, they’re going to need to go in there and repair that bowel. And there are times, depending where it is you, you may or may not come out with a colostomy if that happens. They usually are able to reverse it. They give it three months, they just let that part of the colon heal, and then they can go back in and reconnect it.”
When should someone get checked?
Sommer said, “Severe abdominal pain, or really, any abdominal pain that doesn’t go away. Sometimes people will say, well, it’s intermittent, and comes and goes, and then you’ve had people that have had it before. They call me and they’re like, it’s coming. I know it’s coming. Can I get antibiotics? They want to kick it before it really wreaks havoc. Fever, any fever and abdominal pain, you should get checked out right away. Vomiting, blood in your stool is never a good sign. It’s never normal. Even if you have hemorrhoids, don’t just say, oh, I think it’s my hemorrhoids. Don’t do that. Make sure you get it checked out and again, if the pain doesn’t go away, if it’s persistent, even if it’s an ache spanning a course of days, you want to seek treatment.”
Early treatment can prevent serious complications.
Sommer said, “So diverticulosis is common and often silent, but if you’re told you have it, it could turn into diverticulitis somewhere down the line, and that becomes a very big problem, like we discussed. So lifestyle, especially fiber, is your best friend and good for prevention. And remember, don’t ignore your gut symptoms. Your body is talking to you. It’s telling you something.”
For more information on how Key West Surgical Group can help, click here: https://www.keywestsurgicalgroup.com/